Strategic Innovations to Reduce Disincentives and Increase Living Kidney Donation

This study evaluated how Donor Shield, Donor Connect, and remote donation reduce barriers to living kidney donation. Using data from 103 National Kidney Registry (NKR) Member Centers, we found that NKR initiatives significantly improved donor participation:

1. Immediately after Donor Connect went into effect in March 2021, completion of donor registration and evaluation rose by 8% and continued to grow each quarter.
2. Donors living within 50 miles of their donation center had a significantly higher conversion rate, underscoring how proximity influences participation. Remote donation addressed this barrier by allowing donors to complete the process closer to home, reducing travel by a median of 597 miles. Of the study population, 11% donated through the NKR’s remote donation network.
3. About half (51%) of all donors in the study received Donor Shield reimbursement, and these participants were more racially and ethnically diverse, lived farther from transplant centers, and had lower household incomes. Approximately 30% of the donor population had an annual income under $62,000. After Donor Shield implementation in 2019, the registration conversion rate in this population increased from 21.3% in 2018 to 35.2% in 2024, resulting in an increase in overall donations (20 in 2018 to 137 in 2024).

Our study concludes that the NKR’s donor programs expand access to living donation by streamlining the evaluation process, reducing financial and logistical burdens, and enhancing the overall donor experience.

About Kidney360

Kidney360 is an online-only, open-access journal published by the American Society of Nephrology (ASN). It focuses on advancing kidney research and clinical care by publishing studies on innovative technology, translational science, and global perspectives in nephrology.

Populations of Interest

Our findings point to a major opportunity for growth in living donation among communities that have traditionally faced barriers: racial and ethnic minorities, lower-income individuals, working families, rural and remote residents, and young adults.